Moon Jae Hoon, Lee Eun Kyung, Cha Wonjae, Chai Young Jun, Cho Sun Wook, Choi June Young, Choi Sung Yong, Chu A Jung, Chung Eun-Jae, Hwangbo Yul, Jeong Woo-Jin, Jung Yuh-Seog, Kim Kyungsik, Kim Min Joo, Kim Su-Jin, Kim Woochul, Kim Yoo Hyung, Lee Chang Yoon, Lee Ji Ye, Lee Kyu Eun, Lee Young Ki, Lim Hunjong, Park Do Joon, Park Sue K, Ryu Chang Hwan, Ryu Junsun, Seok Jungirl, Song Young Shin, Yi Ka Hee, Yu Hyeong Won, White Eleanor, Mastrocostas Katerina, Clifton-Bligh Roderick J, Glover Anthony, Gild Matti L, Kim Ji-Hoon, Park Young Joo
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, National Cancer Center, Goyang, Korea.
Endocrinol Metab (Seoul). 2025 Apr;40(2):236-246. doi: 10.3803/EnM.2024.2136. Epub 2025 Feb 18.
Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making.
This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes.
This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.
在日本熊本医院和癌症研究所医院进行开创性试验后，主动监测（AS）已成为低风险甲状腺微小乳头状癌（PTMC）可行的管理策略。此后，众多前瞻性队列研究证实AS是低风险PTMC的一种管理选择，这使其被纳入各国的甲状腺癌指南。2016年至2020年，甲状腺微小乳头状癌主动监测多中心前瞻性队列研究（MAeSTro）纳入了1177例患者，提供了关于PTMC进展、进展的超声预测指标、生活质量、手术结果以及将AS与立即手术相比较时的成本效益的全面数据。MAeSTro的第二阶段（MAeSTro - EXP）将AS扩展至直径大于1 cm的低风险甲状腺乳头状癌（PTC）肿瘤，其依据的假设是在手术决策中总体风险评估比绝对肿瘤大小更重要。
本方案旨在探讨将AS局限于直径小于1 cm的肿瘤是否会导致对在快速初始生长阶段检测到的低风险PTC进行不必要的手术。通过将AS标准扩大到包括直径达1.5 cm的肿瘤，同时完善和标准化风险评估及疾病进展标准，我们旨在尽量减少过度治疗并维持严格监测以改善患者预后。
本研究将有助于优化AS指南，并增进我们对低风险PTC自然病程及适当管理的理解。此外，MAeSTro - EXP涉及韩国和澳大利亚之间的跨国合作。这项跨国研究旨在确定低风险PTC管理中的文化和种族差异，从而丰富全球对AS实践及其在不同人群中适用性的理解。
